Obama to increase medicare reimbursement??

[Zback]

I read in a CNN article that in Obama's new plan, he intends to increase Medicaid reimbursement in certain states, does anyone know which states?

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[RGMSU]

I haven't seen any mention of specific states. Much the same thing has been said about attempts at malpractice reform "in certain states." Again, haven't heard any specific states mentioned.

 

[Dr Oops]

obama has said alotta things. Hes also neglected to follow up or stay true to his word. Hes like every other politician (republican or democrat). I would be cautious in putting faith in his words.

 

[bronx43]

obama has said alotta things. Hes also neglected to follow up or stay true to his word. Hes like every other politician (republican or democrat). I would be cautious in putting faith in his words.

So far, he's been trying to follow through with his biggest promise of reforming healthcare. It's not easy when you have to deal with Republicans, who act like they are fighting for their lives.

 

[Instatewaiter]

He's done this before when he talked about tort reform to the AMA. It is his way of getting people on board before throwing them under the bus and completely reneging on promises.

 

[JaggerPlate]

he's done this before when he talked about tort reform to the ama. It is his way of getting people on board before throwing them under the bus and completely renigging on promises.

+1

 

[MOHS_01]

He's done this before when he talked about tort reform to the AMA. It is his way of getting people on board before throwing them under the bus and completely reneging on promises.

 

[RGMSU]

And what exactly did the previous administration due to solve healthcare access and cost issues? Let me think...hmm... nothing? What do the Republicans want to do now? Hmm... nothing? Is there a pattern here? Instead of just criticizing Pres. Obama or saying "no," let's hear the superior ideas. I watched a great deal of the healthcare summit and didn't hear much in the way of suggestions from Republicans other than, of course, the things Pres. Obama has now said he would be open to including.

 

[Instatewaiter]

Whoops, that looked a bit sketchy on my part. It's fixed (I can't spell well).

 

[Instatewaiter]

And what exactly did the previous administration due to solve healthcare access and cost issues? Let me think...hmm... nothing? What do the Republicans want to do now? Hmm... nothing? Is there a pattern here? Instead of just criticizing Pres. Obama or saying "no," let's hear the superior ideas. I watched a great deal of the healthcare summit and didn't hear much in the way of suggestions from Republicans other than, of course, the things Pres. Obama has now said he would be open to including.

The previous administration didnt do much, nor did the one before that, nor the one before that. If "pro" is the opposite of "con" what is the opposite of progress


Superior ideas:
1) Scrap medicare and medicaid and start over.

2) Have specific hospitals (like the VA system) where people can get health care delivered by the gov't if they don't want to get insurance (creating a 2 tiered system)

3) Pass bills with one issue instead of these massive 1000 page bills so so that pork does not get added. We can all agree that previous conditions should be covered and that insurance companies should be able to compete across state lines. These should be individual bills attached to nothing else. Then we can really see what senators stand on the issues. They can no longer say, well I didn't like the bill because it was full of excess spending.

4) Tort reform. Remove all medical tort cases from the general courts and create a subdivision of the courts where a panel with medical knowledge of the standard of care (ie health professional and lawyers) will hear malpractice cases. Overnight the number of cases would drop because plaintiff lawyers would drop those cases without merit.

5) Have patients pay more for dangerous behaviors. You want to smoke, fine, you have to pay a higher co-pay. You have 35% bodyfat, your co-pay is a bit higher. You show you are losing weight, your co-pay goes back to normal. (this one I'll agree would be dangerous move toward gov't control of lives but hey, if you want to be 400lbs, I shouldn't pay for your CABG)

 

[RGMSU]

(1 and 3) Scrapping Medicare and Medicaid and starting over would require a 1,000 page bill you say you're against. Scrapping Medicare and Medicaid would make access worse, not better. Impractical - good luck finding a politician willing to scrap Medicare and Medicaid. Non-starter that would wind up, again, doing NOTHING.
(2) We already have a two-tiered system. Poor folk and even lower middle class folk without insurance never get healthcare until they show up at the ER, get a bandaid slapped on, and a swift kick in the butt back out the door. Then, twenty years after untreated chronic hypertension and hyperlipidemia, they get on Medicare and require a $100,000 bypass surgery for coronary blockage. Not exactly saving us money or increasing access either, is it?
(3) The issues must be dealt with together. You can't increase regulation of insurance companies without also increasing the pool, because insurance premiums would sky-rocket. You can't increase the pool without mandating coverage, because there will always be a few who "hold out" to let all the rest of us pick up the tab. Trying to pass things piecemeal could wind up making the problem worse rather than better. Healthcare reform is a complicated topic. That's why it requires a sizeable bill. Opposing healthcare reform based on spending is ludicrous on the face of it. If we DON"T reform, healthcare spending is going to break our government.
(4) This is exactly what Pres. Obama has agreed to consider.
(5) Most people identified as smokers do pay higher premiums already, at least if they are buying insurance independently. Some people overweight can't help it - it's called genetics. How do you encourage personal responsibility with reference to health? Mandate insurance coverage so people have to pay something for their healthcare and it has value to them. The opposite is to let people think healthcare is free because they don't have to have coverage, so they do whatever they please. Further, reform of the system to focus more on primary care instead of treating it like a joke in our nation's medical schools and hospitals would go a long way toward encouraging better prevention. It would be great if people could be counseled about risk factors. Primary care doctors do not have the time nor the incentive to do so. Focusing on and funding the primary care "medical home" model would allow people to have access to ancillary primary care personal, NPs, nutritionists, etc, who can take the time to counsel them about basic prevention. This can free primary care MDs/DOs up to serve as executive managers of patients' overall health. Ideally, the primary care physician would be a fully-informed coordinator seeking specific consults. As opposed to the status quo, where a patient sees five different specialists taking the patient in five different directions and the primary care doc has no clue what is going on. The specialists don't know what the other specialists are doing either. That equals duplication, unnecessary treatments, mismanagement, etc.

 

[thedrjojo]

I love the republicans that decry government takeover of healthcare and then in the same breath talk about not touching medicare (government healthcare).

Buying over state lines (especially if put together with removal of anti-trust law protection) is a good idea ONLY if their is a standard, basic, minimum coverage that ALL plans have to support... part of what makes insurance cheaper in different states is what the states mandate is covered... if you don't make all of the plans contain atleast the minimum, all insurance companies will base themselves out of the state with the most lax laws (see LLC all being based out of Delaware).

Tort reform has not changed anything in Texas (where maximum award is $250,000 I believe), yet malpractice is still just as high and "wasteful" spending/defensive medicine is still rampant. And while I don't have where this stat comes from, I believe only 3% of the "healthcare" cost comes from malpractice

Having patients pay more for behaviors... there are many issues with this... if they did this, then I would argue you would need to reform our education system to make sure people were taught the correct information regarding healthy issues, advertising would need to be changed, calories on all restaurant menus (already there), mandatory exercise break time at work... more and more oversight to protect individuals... why stop there, if you are willing to do this, why not take a more active role in this process (or atleast support a more active role): not only Soda tax, why not a fried food tax, a saturated fat tax, fast food tax, outlawing all you can eat buffets, finally making cigarettes illegal, making alcohol illegal (cause that worked so well the first time)... all of these would make people pay for their unhealth lifestlyes.

As for the piece by piece approach, it does make sense, but only if all pieces are treated the same, ie, they all get to go to a simple majority vote... the filabuster is being abused and is now becoming the rule of law, not an exception... but if they did that, we'd get a public option, which would offer competition

Expensive equipment, high insurance company overhead (why not cap overhead at 3% instead of the current overhead these companies have of 30%).

The problem with the system is the system itself... No one is realizing that, according to free market principles, the insurance companies are more successful now then they have ever been, and the current setup is obligated to go to this state. Insurance companies are for profit entities, and as such, their main purpose is to provide profit for their shareholders. They do so by providing a product/service, charging as much as people are willing to give them for giving out as little service as possible. They are free of anti-trust laws, and have no real competition, and in some cases own the companies that advise and set the standard fees (in NY they recently had to pay out billions of dollars for artificially setting fees paid low). As long as profit is the motivation, and competition and selection is not allowed (employers select your insurance for you, and typically do so on a cost analysis only, not on a service analysis or satsifaction analysis...). Health is not a commodity like toliet paper or television sets, but any economic analysis of the system treats it as such. When a CEO of one of these insurance industries makes enough to fund multiple hospitals for an entire year (I think top compensation last year for one CEO was over 1 billion... the University Hospital in Newark NJ which serves as a safety net hospital had an operational cost under $500 million last year to serve 67% medicaid/charity care patients)

 

[dynx]

1. There will be pork and it will cost more than any potential savings.
2. Insurance companies WILL make money. Ever wonder why you cant sue the HMO that denies you coverage? ERISA protects them...THANKS CONGRESS!
3. They have no intention of passing tort reform. They could if they wanted. They offered a f*cking pittance to "study" tort reform. A token measure. NOTHING.
4. People don't "show up in the ER and get a band-aid slapped on". Get out in the real world before you make such dumb statements. They get seen, follow-up arranged at the county clinics, a doctor assigned to them, CALLED and CALLED again...they never show up to thier FREE appointments. THEN they need a CABG and get it free. The system is there, adding more system isnt going to fix stupid and lazy.
5. You can easily pass a single bill to eliminate regulation across state line (this by the way is the administrative advantage medicare/aid has over private insurance) You want to increase the power of the federal gov? Make a federal standard "minimum coverage" insurance policy. Done, no companies hiding in the most lax state. Premiums drop. WHy wont they do this? Well that will drop the cost of doing business for the insurance companies and remove the MAIN ADVANTAGE the fed has. They will no longer be able to say "blah blah blah we spend 97 cents on the dollar on care while they only spend 70 cents blah blah". Who do you think administers medicare? The CMS? they have like 3000 employees. Private companies (mostly blue cross) are contracted, do you think its magic that they administer so well when doing the work for the federal gov. but suck-ass when doing it for themselves?
6. There are multiple studies showing that caps on non-economic damages lower malpractice premiums
7. you cant "cap" overhead. *****
8. Carefull what you ask for when you want the filibustering by-passed. The party you like wont always be in power and you're going to be looking awfully stupid when you try to say its a legit way to hold up ANY bill from now on out because this bill is huge

 

[RGMSU]

(1) People do show up in the ER and get a band-aid slapped on. All day every day. Maybe not at a fancy academic medical center where they receive millions of dollars in private funding, research funding, etc, but it happens all across America in small town hospitals that don't have billionaire benefactors to lean on. Those are probably more "real world" environments than the ones you're referring to. Patients receiving treatment for free is exactly what needs to be fixed. Comprehensive health reform allows more people to pay something into the system, rather than having insurance customers shouldering the costs of other peoples' care or having hospital systems writing off debt that brings them next to bankruptcy.
(2) You are right about one thing - you're concern that other political parties may bypass filibuster when they're in control. They already have. Yeah, the Republicans have bypassed filibusters to. Read some history/political science every once in a while to educate yourself.
(3) Accusing everybody you disagree with of "not being in the real world" or being a "*****" doesn't prove much other than (A) you don't know how to debate, (B) you probably don't have anything constructive to offer or you'd be offering it instead of resorting to personal attacks.

 

[dynx]

(1) People do show up in the ER and get a band-aid slapped on. All day every day. Maybe not at a fancy academic medical center where they receive millions of dollars in private funding, research funding, etc, but it happens all across America in small town hospitals that don't have billionaire benefactors to lean on. Those are probably more "real world" environments than the ones you're referring to.

Okay chief. Lets see, I've worked at 7 different hospitals public and private. All had a county hospital/clinic referal setup for patients without insurance. So here's my offer...you tell me the name of One, just one...single hospital you've worked at that doesnt have this available and I'll find you the community hospital where any of those patients could go for free follow-up care if they chose. Okay? one.

Im sure many other residents/attendings could back me up on this point. Your description is not reality. People get a "bandaid" because they make the choice not to accept long term care.

Patients receiving treatment for free is exactly what needs to be fixed. Comprehensive health reform allows more people to pay something into the system, rather than having insurance customers shouldering the costs of other peoples' care or having hospital systems writing off debt that brings them next to bankruptcy.

yes it does. Im glad we agree.

(2) You are right about one thing - you're concern that other political parties may bypass filibuster when they're in control. They already have. Yeah, the Republicans have bypassed filibusters to. Read some history/political science every once in a while to educate yourself..

Oh wow. I feel so educated. Oh no wait. I knew that. And I said it was a bad idea then as well. Im not a republican Im a libertarian. I wouldnt vote for a republican if you paid me. Did YOU know about prev. filibuster episodes before Pelosi told you?

(3) Accusing everybody you disagree with of "not being in the real world" or being a "*****" doesn't prove much other than (A) you don't know how to debate, (B) you probably don't have anything constructive to offer or you'd be offering it instead of resorting to personal attacks.

Listen...

First let me quote for posterity:

Expensive equipment, high insurance company overhead (why not cap overhead at 3% instead of the current overhead these companies have of 30%).

anyone that thinks you can "cap" overhead is an idiot. "jesus...how am I going to get rid of all the cost of doing business?...oh jeez wait I'LL CAP IT! that way I wont spend more than 3% of what I make!!!!" For christs sake. If you're this stupid you need to shut the hell up and NOT offer advice or ideas. The ONLY way this person is going to realize how dumb they are is a shock to thier system. I tried to apply that gently....the word "*****" may sound harsh, but the beating this ***** is going to take when the intelligent/evil folks like bernie maddoff get ahold of him and rip him off is going to be much harsher. If he realizes he's an idiot and shouldnt make any big decisions he'll be better off.

and, for the record it proves that:
A. I can clearly identify a *****
B. you can't

thanks.

 

[RGMSU]

Hi, chief. Equating a referral system based on providers willing to do pro-bono work with the same kind of care someone on high quality insurance gets is naive. I have been involved with community healthcare centers. They might have one specialist provider come in once a month for one morning to do pro-bono cases. Wow. That's going to get all 30 million uninsured Americans cared for isn't it?

Again, though, dude, you're throwing a red herring out at this thing. You want to argue about post-ER follow-up, and you're missing the whole point of my post. The point of my post (and I don't know a single ER doc or resident who wouldn't agree with THIS) is that someone showing up to the ER and using it as a primary care stop because they don't have insurance is not an effective system. Yet, this is precisely what happens all to frequently. That's the band aid I was referring to.

Many of the people who you think don't follow up on care because they don't want to in reality don't follow up because they can't AFFORD it, or they don't want to go around begging for charity.

For the record, I have followed some of these patients who receive pro-bono care. If you were being honest, you would admit that they often receive fewer treatments, interventions, and diagnostics because they are a pro-bono case. I specifically know of instances where physicians reduced intervals of therapy or skipped expensive diagnostic follow-ups (CT) because they knew they wouldn't be reimbursed for it. Would this happen with a patient on insurance, or for that matter Medicare and Medicaid? Nope. You can stick your head in the sand, but there are people falling through the cracks. They're not poor winos, who are probably on Medicaid. And they're not upper middle class folk with insurance. They're the lower and middle middle class people who do a lot of the work in this country. These people are being shut out of a system that is designed to work against them if they are not part of an insurance pool or if they happen to be unlucky enough to have a pre-existing condition. That's the playing field that needs to be leveled out. It's just common sense.

I am not dependent on Speaker Pelosi for a history lesson. I happen to have earned an MA in history before I applied to medical school.

For the record, I don't think capping insurance company overhead is a way to streamline a system that is already a bureaucratic nightmare. Though the insurance companies definitely need some additional regulation, or someone else will be forced to step in to provide an alternative for the people falling through the cracks (public option). You can't have it both ways - either we're going to reform the insurance industry to accommodate these people or we're going to have a government program that accommodates them.

Now, if you want to have an intelligent dialogue about whether the current system is sustainable (which it isn't) or appropriate alternatives to repair it (I haven't heard any), then have at it. Otherwise, I don't have the time or the inclination to play racquetball with a bunch of generalities and insults. Let's hear some specific facts instead of just smack.

 

[Instatewaiter]

Tort reform has not changed anything in Texas (where maximum award is $250,000 I believe), yet malpractice is still just as high and "wasteful" spending/defensive medicine is still rampant. And while I don't have where this stat comes from, I believe only 3% of the "healthcare" cost comes from malpractice

Tort reform has decreased malpractice cases and premiums by 30% in Texas in just 6 years.

Defensive medicine will take years to get rid of. THe mind set is still CYA- and that is expensive. Tort reform is just the first step in stopping this mindset.

Hi, chief. Equating a referral system based on providers willing to do pro-bono work with the same kind of care someone on high quality insurance gets is naive. I have been involved with community healthcare centers. They might have one specialist provider come in once a month for one morning to do pro-bono cases. Wow. That's going to get all 30 million uninsured Americans cared for isn't it?

And why should they be equal?

The point of my post (and I don't know a single ER doc or resident who wouldn't agree with THIS) is that someone showing up to the ER and using it as a primary care stop because they don't have insurance is not an effective system. Yet, this is precisely what happens all to frequently. That's the band aid I was referring to.

I would agree that using the ER is not an effective system for primary care. However, certain populations use the ER for primary care even though they have a PCP.

I can tell you from experience that much of the population that my hospital deals with goes to the ER for their primary care DESPITE being given free insurance through the hospital and having a PCP in the hospital. They have insurance.

I specifically know of instances where physicians reduced intervals of therapy or skipped expensive diagnostic follow-ups (CT) because they knew they wouldn't be reimbursed for it.

Ummm... what doctors get reimbursed for CTs they order. I think that is called a kick-back and I think it is illegal.

 

[thedrjojo]

Okay chief. Lets see, I've worked at 7 different hospitals public and private. All had a county hospital/clinic referal setup for patients without insurance. So here's my offer...you tell me the name of One, just one...single hospital you've worked at that doesnt have this available and I'll find you the community hospital where any of those patients could go for free follow-up care if they chose. Okay? one.

Im sure many other residents/attendings could back me up on this point. Your description is not reality. People get a "bandaid" because they make the choice not to accept long term care.



yes it does. Im glad we agree.



Oh wow. I feel so educated. Oh no wait. I knew that. And I said it was a bad idea then as well. Im not a republican Im a libertarian. I wouldnt vote for a republican if you paid me. Did YOU know about prev. filibuster episodes before Pelosi told you?



Listen...

First let me quote for posterity:

anyone that thinks you can "cap" overhead is an idiot. "jesus...how am I going to get rid of all the cost of doing business?...oh jeez wait I'LL CAP IT! that way I wont spend more than 3% of what I make!!!!" For christs sake. If you're this stupid you need to shut the hell up and NOT offer advice or ideas. The ONLY way this person is going to realize how dumb they are is a shock to thier system. I tried to apply that gently....the word "*****" may sound harsh, but the beating this ***** is going to take when the intelligent/evil folks like bernie maddoff get ahold of him and rip him off is going to be much harsher. If he realizes he's an idiot and shouldnt make any big decisions he'll be better off.

and, for the record it proves that:
A. I can clearly identify a *****
B. you can't

thanks.

i appologize for not completely developing my thought there... i was referring to the swiss system that the ama touts as the answer to health insurance. the law states that for the basic plan overhead and administrative costs can only be 3.5 percent of their costs... this is what medicare claims as its overhead while private insurance companies in the us take 30% from their premiums for overhead. some overhead costs are fixed like buildings etc and others are fluid such as salaries and profit margins.

as for the filabuster, in the time when a filabuster had to actually filabuster and not just threaten to do it,. it was used roughly 3% of the time. as they have changed it to only having to threaten to filabuster it has steadily increased from the mid 80s of about 30% to currently where i believe something like 80% of all bills are being held hostage by the filabuster. the dems need to force the republicans to actually filabuster instead of allowing them to just shelve everything due to threat of filabuster... just because you disagree with somethingg but you know it will pass doesnt mean you can and should filabuster it. no wonder congress cant get anything done.

i appologize for being wrong about texas tort reform... i had never heard the 30% decrease in premiums and have heard that it was uneffected so i guess i need more research in the matter.

no one has addressed my issue of the for profit status of insurance companies and that as long as this model stays that the health care system will continue as is becuase it is doing exactly as the forces of the market dictate they should

 

[MOHS_01]

i appologize for not completely developing my thought there... i was referring to the swiss system that the ama touts as the answer to health insurance. the law states that for the basic plan overhead and administrative costs can only be 3.5 percent of their costs... this is what medicare claims as its overhead while private insurance companies in the us take 30% from their premiums for overhead. some overhead costs are fixed like buildings etc and others are fluid such as salaries and profit margins.

as for the filabuster, in the time when a filabuster had to actually filabuster and not just threaten to do it,. it was used roughly 3% of the time. as they have changed it to only having to threaten to filabuster it has steadily increased from the mid 80s of about 30% to currently where i believe something like 80% of all bills are being held hostage by the filabuster. the dems need to force the republicans to actually filabuster instead of allowing them to just shelve everything due to threat of filabuster... just because you disagree with somethingg but you know it will pass doesnt mean you can and should filabuster it. no wonder congress cant get anything done.

i appologize for being wrong about texas tort reform... i had never heard the 30% decrease in premiums and have heard that it was uneffected so i guess i need more research in the matter.

no one has addressed my issue of the for profit status of insurance companies and that as long as this model stays that the health care system will continue as is becuase it is doing exactly as the forces of the market dictate they should

A couple of observations:

- it's filibuster

- MC's 3% administrative claim is bogus. There exists data and analysis that dispels that myth.

- The numbers being thrown about on the topic of private insurer's medical services payout on a percentage basis is convoluted and somewhat misleading. The medical loss ratio varies from plan to plan, year to year, and state to state. A snapshot review is inadequate to render a global judgement.

- the purpose of the filibuster is to provide a counterbalance against the tyranny of the majority (in the political body). It is a crucial piece of our system of checks and balances, and is sorely needed on this matter.

 

[thedrjojo]

A couple of observations:

- it's filibuster

- MC's 3% administrative claim is bogus. There exists data and analysis that dispels that myth.

- The numbers being thrown about on the topic of private insurer's medical services payout on a percentage basis is convoluted and somewhat misleading. The medical loss ratio varies from plan to plan, year to year, and state to state. A snapshot review is inadequate to render a global judgement.

- the purpose of the filibuster is to provide a counterbalance against the tyranny of the majority (in the political body). It is a crucial piece of our system of checks and balances, and is sorely needed on this matter.

The filibuster (sorry for my misspelling) historically is important, but currently has been used as a rule of law, not the exception. Even if it may be required on a bill of this magnitude, the simple fact that Republicans use it on nearly every piece of legislature means that it has become abused and needs to be changed... just because the minority party disagrees with something, does not make it tyranical to pass any piece of legislature. And this healthcare bill and debate is not as such, and actually became weaker and full of pork because having to appease individuals in order to "break the filibuster".

I even put that this is what medicare claims... I know it is incorrectly stated as low, but still nothing to the margins seen in private insurance companies, and those margins continue to increase at a rate unsustainable.

 

[lee9786]

Having patients pay more for behaviors... there are many issues with this... if they did this, then I would argue you would need to reform our education system to make sure people were taught the correct information regarding healthy issues, advertising would need to be changed, calories on all restaurant menus (already there), mandatory exercise break time at work... more and more oversight to protect individuals... why stop there, if you are willing to do this, why not take a more active role in this process (or atleast support a more active role): not only Soda tax, why not a fried food tax, a saturated fat tax, fast food tax, outlawing all you can eat buffets, finally making cigarettes illegal, making alcohol illegal (cause that worked so well the first time)... all of these would make people pay for their unhealth lifestlyes.

I agree with this concept. Obesity is a serious underlying problem that's going to be a primary contributor to healthcare costs for the next couple decades. It's also something that can be prevented. I believe it goes deeper than the individual level to a more societal level where behavior modification is the focus. The best behavior modifier in this country is money. So manipulating the market by taxing certain products such as soda might be a good idea. One thing though would be making the price transparent. So instead of selling a six pack of soda for $1.50 and putting a hidden $1.50 tax on it in which the consumer finds out later, sell it for ~$3.00 with the usual tax. So I guess the tax would be on the distributor which would be passed onto the consumer.

While the consumption curve could be manipulated through economics, I believe the exercise/activity curve could be as well. First from what I hear schools are looking to cut back on recess. Does this make sense to anybody? If anything they should have two sessions if you ask me. Gym class should be geared towards productive activity which should help promote weight loss. The exercise should enhance attention and performance as well. The childhood obesity epidemic is a huge problem that needs to be dealt with.

The system should be adjusted for everyone. Increased access to health facilities and health professionals such as dietitians, physical therapists, athletic trainers, et al should be increased. Decrease the out-of-pocket costs for these services should occur to encourage utilization. Provide an economic incentive for the individual to lose weight and sustain the normal BMI. Economic incentive could be provided by 1) decrease in health insurance monthly premiums, or 2) implementation of a income tax cut for objective BMI results showing weight loss and maintenence. So basically it's a "fat tax" but stated in a less derogatory manner.

Just to clear up one point on obesity, it is widely believed among scientists that the current obesity epidemic is not due to genetics. Reason being is the rate of obesity has increased much faster than genetic polymorphisms/mutations take place. There is a clear cut association with production/consumption of sugar and obesity however. The biggest most important thing is the calorie equation. I don't think the current system of pleading and lecturing the patient down a long declining road to the dialysis center is working. I like the idea of influencing the market with intention of modifying behavior through economics. I think that would work.

 

[docB]

For the record, I have followed some of these patients who receive pro-bono care. If you were being honest, you would admit that they often receive fewer treatments, interventions, and diagnostics because they are a pro-bono case. I specifically know of instances where physicians reduced intervals of therapy or skipped expensive diagnostic follow-ups (CT) because they knew they wouldn't be reimbursed for it.

Ummm... what doctors get reimbursed for CTs they order. I think that is called a kick-back and I think it is illegal.

I’ve got to agree with Instate on this. If a PMD is not ordering tests for a poor patient it’s not because they’re not going to get reimbursed. They don’t get reimbursed for that type of thing. If they’re ordering less they could be doing it because they know the patient won’t be able to get it done or because they’re tailoring care to do what’s necessary rather than what’s defensive.

The point of my post (and I don't know a single ER doc or resident who wouldn't agree with THIS) is that someone showing up to the ER and using it as a primary care stop because they don't have insurance is not an effective system.

That’s true. Using the ED for primary care results in huge expenses and poor primary care.

I would agree that using the ER is not an effective system for primary care. However, certain populations use the ER for primary care even though they have a PCP.

It is true that there are some studies that show that the majority of patients who come to the ED with primary care issues do have insurance.

 

[RGMSU]

Ummm... what doctors get reimbursed for CTs they order. I think that is called a kick-back and I think it is illegal.

I really haven't had a chance to get back on here and reply to some of this. However, since two people have mentioned it already. Yes, CT was a poor word choice. I was really referring to in-house diagnostics, and CT would not be a good example. In the particular case I was referring to, the patient had a significant outstanding bill with the physician (so treatment frequencies were diminished), and the patient was dependent on pro-bono hospital care. It seemed to me that the physician was less likely to order hospital diagnostics, such as CT, because it was known that it would not be paid for. I didn't mean that the physician had a personal financial stake in it, but just made more of a decision to scale back care to save everybody money, etc.

Again, though, red herring. The point was that more money is spent on care more willingly when people have means to pay. Less money is spent, and it is spent less willingly, when the care is pro-bono. A lot of people who fall through the cracks of being too rich for Medicaid and too poor for insurance get the minimum amount of care absolutely necessary. If they are lucky enough to find pro-bono providers, they get adequate care. If not, they don't. That was the thrust of my statement.

 

[RGMSU]

It is true that there are some studies that show that the majority of patients who come to the ED with primary care issues do have insurance.

(1) We need to teach patients what an emergency is.
(2) We need more urgent care centers for minor emergencies.
(3) We need MORE PRIMARY CARE PHYSICIANS so that they have MORE TIME IN THEIR SCHEDULES to take a patient MORE QUICKLY who has a primary care problem.

 

[MOHS_01]

(1) We need to teach patients what an emergency is.
(2) We need more urgent care centers for minor emergencies.
(3) We need MORE PRIMARY CARE PHYSICIANS so that they have MORE TIME IN THEIR SCHEDULES to take a patient MORE QUICKLY who has a primary care problem.

Again, help me out here... how will more providers, more access, and more services... along with higher reimbursement to the providers translate into lower costs again?

 

[Instatewaiter]

Again, help me out here... how will more providers, more access, and more services... along with higher reimbursement to the providers translate into lower costs again?

Isn't that the basics of Obamanomics?

Take things that could never work together, tell people it will work, and then blame another group (congress, republicans, the tea party movement, blue dog democrats etc) when it doesn't work or doesn't pass.

 

[badasshairday]

On a side note: I can't wait till Obama gets the boot in 2012.

This country is going to ****. Why are many of my fellow countrymen so freakin stupid?

 

[bronx43]

On a side note: I can't wait till Obama gets the boot in 2012.

This country is going to ****. Why are many of my fellow countrymen so freakin stupid?

Given how the alternative was a 73 year old man and a ignorant Alaskan soccer mom, I'd take Obama everyday of the week and twice on Sunday.

 

[thedrjojo]

Given how the alternative was a 73 year old man and a ignorant Alaskan soccer mom, I'd take Obama everyday of the week and twice on Sunday.

Well put... the astroturf tea baggers make me laugh... palin just makes me cry.

 

[JaggerPlate]

Given how the alternative was a 73 year old man and a ignorant Alaskan soccer mom, I'd take Obama everyday of the week and twice on Sunday.

Damn seasoned senators/war heroes ... I hate how their experience and knowledge always interferes with their ability to run slick ad campaigns and not know what the **** they are doing. Palin is insane and she should be no where near the office of president (especially when John is so damn old), but I can imagine few people doing a worse job right now than Obama.

 

[RGMSU]

I can imagine few people doing a worse job right now than Obama.

I can - he just left office 14 months ago.

 

[JaggerPlate]

I can - he just left office 14 months ago.

Don't you have to receive written consent before using the patented, official Obama administration diversion tactic???


It was 14 months ago ... let's move on and take some responsibility here. Everyone knows some of the things happening now are a result of the last 8 years (ie the economy), and most people also know these problems can't be fixed overnight, but, like you said, it's been 14 months and the "blame it on Bush" tactic is getting old.

 

[RGMSU]

Again, help me out here... how will more providers, more access, and more services... along with higher reimbursement to the providers translate into lower costs again?

Simple - more primary care providers, more early interventions, fewer late and more costly interventions because nobody bothered to give a rip about primary care when it would have done some good. Higher reimbursement to primary care physicians attracts more medical students to primary care, providing more providers with more training (ie, physicians) and more skills to perceive more problems before they become more complicated and require more money to repair. More people in the system translates to more money spread around and more patients able to provide more compensation, so that a few patients aren't asked to pay more than their treatment is worth, which makes the cost of their premiums more. Doctors win because more patients can pay since they have at least some coverage.

The alternative is to have higher compensation to specialists and proceduralists, encouraging more medical students to enter those fields, leaving primary care to non-physician providers, resulting in more early diagnoses missed, more instances of mismanagement, more money spent on needless diagnostics and consults requested by less experienced and educated providers. Not to mention more procedures performed (because that's what drives our sick-care system), resulting in more costs that more and more patients are unable to pay, resulting in more patients without coverage, doctors and hospitals absorbing more pro-bono costs, more costs to government and private third party payers to pay for more expensive treatments that could have been avoided if more primary care physicians had more time to work with their patients and there was more incentive for physicians to not focus on doing more procedures and diagnostics. And, there we are back where we started.

 

[RGMSU]

It took more than 14 months to get over Herbert Hoover too. For the record, I am not part of the Bush bashing crowd. I am not an idealogue. There are some things Bush did RIGHT. Much of the economy was not under his control, just like it isn't all under Obama's control. Point is that there are some folks who should give Obama a chance to succeed instead of being purely partisan.

 

[JaggerPlate]

It took more than 14 months to get over Herbert Hoover too. For the record, I am not part of the Bush bashing crowd. I am not an idealogue. There are some things Bush did RIGHT. Much of the economy was not under his control, just like it isn't all under Obama's control. Point is that there are some folks who should give Obama a chance to succeed instead of being purely partisan.

Yeah, I like to think I'm not one of the people who simply want Obama to fail because he's Obama, but so far ... not his biggest fan.

 

[MOHS_01]

It took more than 14 months to get over Herbert Hoover too. For the record, I am not part of the Bush bashing crowd. I am not an idealogue. There are some things Bush did RIGHT. Much of the economy was not under his control, just like it isn't all under Obama's control. Point is that there are some folks who should give Obama a chance to succeed instead of being purely partisan.

Holy tap dancing...... tell me that you did not just throw a prop to FDR.

 

[MOHS_01]

Simple - more primary care providers, more early interventions, fewer late and more costly interventions because nobody bothered to give a rip about primary care when it would have done some good. Higher reimbursement to primary care physicians attracts more medical students to primary care, providing more providers with more training (ie, physicians) and more skills to perceive more problems before they become more complicated and require more money to repair. More people in the system translates to more money spread around and more patients able to provide more compensation, so that a few patients aren't asked to pay more than their treatment is worth, which makes the cost of their premiums more. Doctors win because more patients can pay since they have at least some coverage.

The alternative is to have higher compensation to specialists and proceduralists, encouraging more medical students to enter those fields, leaving primary care to non-physician providers, resulting in more early diagnoses missed, more instances of mismanagement, more money spent on needless diagnostics and consults requested by less experienced and educated providers. Not to mention more procedures performed (because that's what drives our sick-care system), resulting in more costs that more and more patients are unable to pay, resulting in more patients without coverage, doctors and hospitals absorbing more pro-bono costs, more costs to government and private third party payers to pay for more expensive treatments that could have been avoided if more primary care physicians had more time to work with their patients and there was more incentive for physicians to not focus on doing more procedures and diagnostics. And, there we are back where we started.

I had a long response typed out and lost it due to this blasted dropped wireless signal....

In short, I kinda knew you were going to say that. Here's the problem: you don't have the data to back it up. In fact, much data exists that refutes the point... or demonstrates that it is a wash at best. Medicare tried some pilot sites where they expanded access to PCP services and they failed (miserably to the dismay of the elites who designed them) to demonstrate a statistically significant decrease in the cost endpoints being measured. Further, look at those areas of "preventative care" where we have actually turned a critical eye: the mammography blow up, the Pap smear recommendation changes, DRE's, fecal occult blood, CXR's for lung Ca in smokers, etc. Did they work? Maybe. Were they cost effective? Not conclusively at best and cost prohibitive in others.

Walk me through this: should you not demonstrate some modicum of evidence of a working model prior to f'ing with hundreds of thousands -- if not millions of livelihoods? What you are arguing for is the diminished access to interventions and a redistribution of dollars that is more aligned with your personal beliefs. That is authoritarian BS. So take your MSNBC / Barry O talking points and try to find some justification other than "I think..." -- because thought and theory without proof have no merit.

 

[Hernandez]

Simple - more primary care providers, more early interventions, fewer late and more costly interventions because nobody bothered to give a rip about primary care when it would have done some good. .

So when did I miss he land breaking study that primary care and prevenitive medicine led to long term cost savings?

 

[thedrjojo]

I had a long response typed out and lost it due to this blasted dropped wireless signal....

In short, I kinda knew you were going to say that. Here's the problem: you don't have the data to back it up. In fact, much data exists that refutes the point... or demonstrates that it is a wash at best. Medicare tried some pilot sites where they expanded access to PCP services and they failed (miserably to the dismay of the elites who designed them) to demonstrate a statistically significant decrease in the cost endpoints being measured. Further, look at those areas of "preventative care" where we have actually turned a critical eye: the mammography blow up, the Pap smear recommendation changes, DRE's, fecal occult blood, CXR's for lung Ca in smokers, etc. Did they work? Maybe. Were they cost effective? Not conclusively at best and cost prohibitive in others.

Walk me through this: should you not demonstrate some modicum of evidence of a working model prior to f'ing with hundreds of thousands -- if not millions of livelihoods? What you are arguing for is the diminished access to interventions and a redistribution of dollars that is more aligned with your personal beliefs. That is authoritarian BS. So take your MSNBC / Barry O talking points and try to find some justification other than "I think..." -- because thought and theory without proof have no merit.

I actually agree with what you are saying here... prevention and screening is actually more COSTLY, and in many cases simply don't work. I mean, the cheapest thing is to do nothing for anyone, which insurance companies actually try to pay for as little as they can possibly get away with. One of the best things Obama/Congress provided money for early on was Comparative Analysis Research, which was decryed mainly on the right as the government telling doctors how to treat patients. Mammography has not really blown up, the recommendation has changed from every year to every other year, but they still are a very powerful screening tool... Pap smears have also been proven effective but like you said the recommendations have changed... Immunizations have worked wonderfully to eliminate things like Polio, and Paragaurd can do wonders for HPV/Cervical Cancer if right wing/religious fanatics didn't object to that as well. One thing all this is showing is that medicine is EVIDENCE BASED and that progress advances care and the fluidity of knowledge.

 

[MOHS_01]

so when did i miss he land breaking study that primary care and prevenitive medicine led to long term cost savings?

 

[bronx43]

Damn seasoned senators/war heroes ... I hate how their experience and knowledge always interferes with their ability to run slick ad campaigns and not know what the **** they are doing. Palin is insane and she should be no where near the office of president (especially when John is so damn old), but I can imagine few people doing a worse job right now than Obama.

I didn't mean that McCain wasn't fit for office - just that he's old and his second in command is barely literate.

As for Obama doing a bad job, he's at least trying to push through legislation that he promised during his campaign. Whether or not I agree with said legislation is a different matter, but it's absurdly inconsistent to have wanted McCain in office, while trashing Obama for not being able to pass a bill (yet) in the face of McCain's own party.

 

[MOHS_01]

Don't you have to receive written consent before using the patented, official Obama administration diversion tactic???

It was 14 months ago ... let's move on and take some responsibility here. Everyone knows some of the things happening now are a result of the last 8 years (ie the economy), and most people also know these problems can't be fixed overnight, but, like you said, it's been 14 months and the "blame it on Bush" tactic is getting old.

Please be so kind as to expound....

 

[RGMSU]

So when did I miss he land breaking study that primary care and prevenitive medicine led to long term cost savings?

You can't be serious.

 

[RGMSU]

Further, look at those areas of "preventative care" where we have actually turned a critical eye: the mammography blow up, the Pap smear recommendation changes, DRE's, fecal occult blood, CXR's for lung Ca in smokers, etc. Did they work? Maybe. Were they cost effective? Not conclusively at best and cost prohibitive in others..

If you're questioning the validity of mammography, paps, and fecal occult blood as valuable early screening tools, then you and I must be in two different universes. I know too many peoples' lives who've been saved by each.

Walk me through this: should you not demonstrate some modicum of evidence of a working model prior to f'ing with hundreds of thousands -- if not millions of livelihoods? What you are arguing for is the diminished access to interventions and a redistribution of dollars that is more aligned with your personal beliefs. That is authoritarian BS. So take your MSNBC / Barry O talking points and try to find some justification other than "I think..." -- because thought and theory without proof have no merit.

There are working models in every other industrialized country on the planet. Some of them are working just rosey. England, say. Plus, if we were always sure of every single detail of some big undertaking before we did it, as a practical matter, we'd never change anything. Don't try to dismiss all this as MSNBC talking points. I watch FOX News and CNN just as much if not more so. I am not an ideologue. I am not a liberal. Thought and theory without proof? You have no proof that the system being described would not work, do you? Show me the irrefutable evidence that healthcare in England leads to lower quality of care for its citizens, lower pay for physicians, or more "out of control" healthcare costs compared to the US. Oh, whoops, actually you can't, because those statements would be "thought and theory without proof," naturally having "no merit" to you. In the words of Ebenezer, I believe I'll retire to bedlam.

 

[Hernandez]

You can't be serious.

I'm very serious. All these claims about preventive medicine are hog-wash and unsubstantiated and until there is some data behind it, wishful thinking.

And while I can't speak for MOHS_01, personally, it's not that mammos/pap/colonoscopys aren't worthwhile (FOB/DRE/PSA are really a waste of time) they are not the panacea of cost savings and preventative medicine they are made out to be.

 

[deleted87716]

I'm very serious. All these claims about preventive medicine are hog-wash and unsubstantiated and until there is some data behind it, wishful thinking.

And while I can't speak for MOHS_01, personally, it's not that mammos/pap/colonoscopys aren't worthwhile (FOB/DRE/PSA are really a waste of time) they are not the panacea of cost savings and preventative medicine they are made out to be.

There's a lot more to primary care than preventive medicine, and there's plenty of value in good primary care.

http://www.aafp.org/online/en/home/policy/familymedvalue.html

 

[Hernandez]

There's a lot more to primary care than preventive medicine, and there's plenty of value in good primary care.

http://www.aafp.org/online/en/home/policy/familymedvalue.html

BD, I'm an internist, so I'm aware of what goes on and where the value of a good PCP is. I'm not bashing PCP or primary care or most preventive medicine, but I do get tired of all the dogma that is being thrown around that is simply as baseless assumption that preventive medicine is going to save money (and the world)

 

[DrBowtie]

I didn't mean that McCain wasn't fit for office - just that he's old and his second in command is barely literate.

As for Obama doing a bad job, he's at least trying to push through legislation that he promised during his campaign. Whether or not I agree with said legislation is a different matter, but it's absurdly inconsistent to have wanted McCain in office, while trashing Obama for not being able to pass a bill (yet) in the face of McCain's own party.

I think the 2nd in command argument is a terrible one considering Biden isn't much better than Palin. Besides being VP is easy according to Biden, you don't do any work!

 

[thedrjojo]

Damn seasoned senators/war heroes ... I hate how their experience and knowledge always interferes with their ability to run slick ad campaigns and not know what the **** they are doing. Palin is insane and she should be no where near the office of president (especially when John is so damn old), but I can imagine few people doing a worse job right now than Obama.

McCain has undergone a metamorphosis over the past 8 years from almost every standpoint. Jon Stewart on the dailyshow has chronicalled this very well, pretty much having 2000 McCain debate 2008 McCain on one of his segments. I don't know if this is a product of seeing Bush's success pandering to the religious social conservative base, of him having the onset of a mental disease of the elderly, or what, but he is a perfect example of the career polititian and the extremes the republican party has become. While I am too young to really have changed parties, I originally registured Republican when I first was able to vote, and only recently (thanks mainly to the Bush and Religious Social Conservatives) changed Democratic. We need term limits for senators and representatives, and we need to stop having political office be a profession and instead have it be a public service again.

 

[thedrjojo]

I think the 2nd in command argument is a terrible one considering Biden isn't much better than Palin. Besides being VP is easy according to Biden, you don't do any work!

If you consider Biden unqualified, well, besides not being a war hero (which doesn't qualify you to be POTUS), he has just as much public office and foreign policy (even more there) experience than McCain does. Biden is more qualified and much more appropriate in his role than Chaney was as VP, and probably moreso than Gore was.